Guide to
Depression and
Bipolar Disorder
Depression and Bipolar
Support Alliance (DBSA)
Previously National Depressive and Manic-Depressive Association
We’ve been there. We can help.
“
Promoting mental
health for all Americans
will require scientific know-how but,
even more importantly, a societal
resolve that we will make the needed
investment. The investment does not
call for massive budgets; rather, it calls
for the willingness of each of us to educate ourselves and others about mental
health and mental illness, and thus to
confront the attitudes, fear, and misun-
You are not alone
D
epression and bipolar disorder (also known as
manic-depression) are both highly treatable
medical illnesses. So why do so few people get
the treatment they need? There are many reasons, but
one of the main ones is the lack of accurate information
patients and their families can understand. Many people
think that these illnesses will go away by themselves or
that getting help is a sign of weakness or moral failure.
These views are incorrect. That’s why DBSA created this
guide.
This booklet will discuss depression and bipolar disorder, their symptoms and their treatments. It will provide
general guidance on the best resources and support. It
will also inform you about DBSA, its mission and its
nationwide network of patient and family support
groups.
Part of DBSA’s mission is to help you help yourself –
whether you have one of these illnesses or know someone who does. Reading this Guide to Depression and
Bipolar Disorder is one of the first steps on the road to
recovery.
derstanding that remain as barriers
”
before us.
David Satcher, M.D., Ph.D.
United States Surgeon General
from Mental Health: A Report of the
Surgeon General, issued December 1999
DBSA, its advisors and consultants do not
endorse or recommend the use of any
specific treatments or medications listed
in this publication. For advice about specific treatments or medications,
individuals should consult their physicians and/or mental health professionals.
Depression
2
Bipolar Disorder
6
Treatment
12
Support
20
Resources
26
DBSA Services
28
If you are thinking about death or
suicide, go to a hospital emergency room,
or contact a medical professional, clergy
member, loved one or friend immediately!
Depression
It’s Not Just in
Your Head
Everyone, at various times
in life, feels sad or “blue.”
It’s normal to feel sad on
occasion. Sometimes this sadness comes from things
that happen in your life: you move to a different city
and leave behind friends, you lose your job or a loved
one dies. But what’s the difference between “normal”
feelings of sadness and the feelings caused by clinical
depression?
While it’s normal for people to experience ups and
downs during their lives, those who have clinical
depression experience specific symptoms daily for two
weeks or more, making it difficult to function at work,
at school and in relationships.
Clinical depression is a treatable medical illness marked
by changes in mood, thought and behavior. That’s why
doctors call it a mood disorder. In this booklet, the term
“depression” is used to refer to clinical depression.
How to Recognize Depression
Depression is not a character flaw or sign of personal
weakness. You can’t make yourself well by trying to
“snap out of it” or “lighten up.” And you can’t catch it
from someone else, although it can run in families. To
understand what depression is, it’s important to recognize the symptoms:
If you experience five or more of these symptoms for
more than two weeks or if any of these symptoms interfere with work or family activities, contact your doctor
for a thorough examination. This includes a complete
physical exam and a review of your family’s history of illness. Do not try to diagnose yourself. Only a health care
professional can determine if you have depression.
Types of Depression
It is now believed that depression is the sign of an
imbalance in brain chemicals called neurotransmitters.
Although the direct causes of the illness are unclear, it is
known that body chemistry can bring on a depressive
disorder, due to the presence of another illness, altered
health habits, substance abuse or hormonal changes.
People who have major depressive disorder have
had at least one major depressive episode – five or more
symptoms for at least a two-week period. For some
people, this disorder is recurrent, which means they
may experience episodes every so often: once a month,
once a year or several times throughout their lives. Each
person is different.
■
Prolonged sadness or unexplained crying spells
■
Feelings of guilt, worthlessness
and/or hopelessness
Dysthymia is a chronic, moderate type of depression.
People with dysthymia usually suffer from poor appetite
or overeating, insomnia or oversleeping, and low energy
or fatigue. People with dysthymia are often largely
unaware that they have an illness because their functioning is usually not greatly impaired. They go to work and
manage their lives, but are frequently irritable, always
complaining about stress or not getting enough sleep.
■
Significant changes in appetite
and sleep patterns
■
Inability to concentrate,
indecisiveness
Who Gets Depression?
■
Irritability, anger, worry,
agitation, anxiety
■
Inability to take pleasure in former interests, social withdrawal
■
Pessimism, indifference
■
■
Loss of energy, persistent
lethargy
Excessive consumption of alcohol
or use of chemical substances
■
Recurring thoughts of death
or suicide
■
2
If you or someone you know has thoughts of
death or suicide, contact a medical professional,
clergy member, loved one or friend immediately.
Unexplained aches and pains
People of all ages, races, ethnic groups, and social classes have the illness. Although it can occur at any age,
depression frequently develops between the ages of 25
and 44. More women experience depression than men.
3
Children and Depression
Postpartum Depression
As many as one in 33 children and one in eight adolescents has depression. If your child has five or more
symptoms for at least two weeks and it interferes with
his or her daily activities (e.g., going to school, playing
with friends), then your child may be clinically
depressed. Other warning signs of childhood depression
include headaches, frequent absences from school,
social isolation and reckless behavior.
Many women feel especially guilty about having depressive feelings at a time when they should be or are
expected to be happy. It’s extremely important to talk
about postpartum feelings, as untreated postpartum
depression can affect the mother-child relationship and,
in severe cases, may put the infant’s and/or mother’s life
at risk.
Childhood depression is not caused by poor parenting.
It may have many origins – genetics, biochemistry and
a variety of other factors. Fortunately, treatment for
childhood depression is highly effective.
One in ten mothers meets the criteria for depression in
the postpartum period. Although most of these women
have only depression, a rare few develop postpartum
psychosis – symptoms of depression and mania appearing in the postpartum period. Both require immediate
treatment when symptoms appear.
Depression and the Elderly
Depression and Other Illnesses
Depression is not a normal part of aging. However, of
the 32 million Americans over the age of 65, nearly five
million experience serious symptoms of depression and
one million suffer from a major depressive disorder.
Elderly people with untreated depression are more likely to have worse outcomes from co-existing medical
illnesses. Untreated depression is the most common
psychiatric disorder and the leading cause of suicide
among the elderly.
Depression often co-exists with other mental or physical
illnesses. Substance abuse, anxiety disorders and eating
disorders are particularly common mental conditions
which may be worsened by depression, and vice versa.
Research is currently being done into the relationship
between depression and physical illnesses. Several recent
studies have noted that when co-existing depression is
treated, prognoses are substantially improved for conditions such as heart disease, AIDS, cancer, Parkinson’s
disease and diabetes. It is important to tell your doctor
about all of the symptoms you are experiencing and all
other illnesses for which you are receiving treatment.
Women and Depression
If you are a woman, you are almost twice as likely as a
man to experience depression. In fact, one in four
women will experience clinical depression in her lifetime. The hormonal and life changes associated with
menstruation, pregnancy, miscarriage, the postpartum
period and menopause may contribute to or trigger
depression. The lifetime prevalence of major depression
is 24 percent for women; for men, it’s 15 percent.
4
The Good News
Of all psychiatric illnesses, depression is one of the
most responsive to treatment. With proper care, approximately 80 percent of people with major depression
demonstrate significant improvement and lead productive lives – even those with severe depression can be
helped. That’s why it’s crucial to learn about the symptoms of depression and act promptly.
5
Bipolar
Disorder
More Than A
Mood Swing
Bipolar disorder, also
known as manic-depression, is a treatable medical illness marked by extreme changes in mood, thought,
energy and behavior. A person’s mood can alternate
between the “poles” of mania and depression. This
change in mood or “mood swing” can last for hours,
days, weeks or even months.
Bipolar disorder affects more than two million adult
Americans. Like depression and other serious illnesses,
bipolar disorder can also adversely affect spouses,
family members, friends and people in the workplace.
It usually begins in late adolescence (often appearing
as depression during teen years) although it can start in
early childhood or as late as the 40s and 50s. An equal
number of men and women develop this illness and it
is found among all ages, races, ethnic groups and social
classes. The illness tends to run in families and is inherited in many cases.
Bipolar disorder differs significantly from clinical depression, although the symptoms for the depressive phase
of bipolar disorder are similar to those listed on page 2.
Mood swings that come with bipolar disorder can be
severe, ranging from extremes in energy to deep
despair. The severity of the mood swings and the way
they disrupt normal activities distinguish bipolar mood
episodes from ordinary mood changes.
Unlike people with clinical (unipolar) depression, most
people who have bipolar disorder talk about experiencing the “highs” and “lows” of the illness. The “highs” are
periods of mania or intense bursts of energy or euphoria.
Symptoms of Mania
■
Increased physical and mental
activity and energy
■
Racing speech, racing thoughts,
flight of ideas
■
Heightened mood, exaggerated
optimism and self-confidence
■
Impulsiveness, poor judgment,
distractability
■
Excessive irritability, aggressive
behavior
■
■
Decreased need for sleep without experiencing fatigue
Reckless behavior such as spending sprees, rash business
decisions, erratic driving and
sexual indiscretions
■
Grandiose delusions, inflated
sense of self-importance
■
In the most severe cases,
delusions and hallucinations
These “highs” and “lows” are frequently seasonal. Many
people who have bipolar disorder report feeling symptoms of depression during fall and winter, and symptoms
of mania and/or hypomania (a less severe form of
mania) during spring.
Types of Episodes
(Refer to symptoms on page 2 and above.)
Manic Episode: A distinct period of persistently
elevated, expansive, or irritable mood, lasting at least
one week. During this period, three or more symptoms
of mania must be present.
Major Depressive Episode: A period of two weeks or
more during which five or more symptoms of depression
are present.
Hypomanic Episode: Similar to a manic episode,
except that delusions or hallucinations are not present
and it is less severe. Must be clearly different from the
individual’s typical nondepressed mood, with a clear
change in functioning and observable behaviors that are
unusual or out-of-character.
Mixed Episode
When symptoms of a manic and a major depressive
episode are both present every day for at least a oneweek period.
Rapid Cycling
Four or more manic, hypomanic, mixed or depressive
episodes in any 12-month period.
6
7
Types of Bipolar Disorder
What Causes Bipolar Disorder?
Different types of bipolar disorder are determined by
patterns of symptoms or episodes. The main types of
bipolar disorder are:
Research has shown the presence of bipolar disorder
indicates an imbalance in brain chemicals called neurotransmitters. Although the direct cause of the illness is
unclear, it is known that genetic, biochemical and environmental factors each play a role. Body chemistry can
bring on a depressive or manic episode, due to the
presence of another illness, altered health habits, stress,
substance abuse, or hormonal changes. In addition,
studies have shown that the illness often runs in families, and that stressful life experiences can trigger some
symptoms.
Bipolar I Disorder
■ One or more manic episodes or mixed episodes and,
often, one or more major depressive episodes.
■
Depressive episode may last for several weeks or
months, alternating with intense symptoms of mania
that may last just as long.
■
Between episodes, there may be periods of normal
functioning.
■
Symptoms may also be related to seasonal changes.
Bipolar II Disorder
■ One or more major depressive episodes accompanied
by at least one hypomanic episode.
■
Hypomanic episodes have symptoms similar to manic
episodes but are less severe.
■
Between episodes, there may be periods of normal
functioning.
■
Symptoms may also be related to seasonal changes.
Cyclothymic Disorder
Chronic, fluctuating mood disturbance involving
periods of hypomanic symptoms and periods of
depressive symptoms.
■
■
Milder form of bipolar disorder; the periods
of both depressive and hypomanic symptoms are
shorter, less severe, and do not occur with regularity.
■
Many but not all people with cyclothymia may ultimately develop a more severe form of bipolar illness.
Bipolar Disorder NOS (Not Otherwise Specified)
Includes disorders with bipolar features that do not
meet criteria for any of the above specified disorders.
For example:
8
■
Having recurrent hypomanic episodes without depressive symptoms.
■
Having very rapid alternation between symptoms of
mania and depression that do not meet the criteria for
a manic episode or major depressive episode.
The Importance of Recognizing Mania
When symptoms of mania are untreated, they can lead to
life-threatening situations. For example, a woman with
mania was injured after crashing her car. She was traveling
at a high speed because she thought she was a race car
driver. A man with mania impulsively invested his life savings in the stock market – and lost it all. These behaviors
vary from person to person, but are typical of untreated
bipolar disorder. Other behaviors include excessive spending, sexual indiscretions and excessive gambling.
Erratic behavior alone does not mean that someone has
bipolar disorder, but when a combination of symptoms
appears for longer than one week, one should see a
mental health professional for immediate evaluation.
Unfortunately, many people with symptoms delay seeking
professional help. The average length of time between
the onset of bipolar symptoms and a correct diagnosis
is ten years. There is real danger involved in leaving
bipolar disorder undiagnosed, untreated or undertreated – people with bipolar disorder who do not receive
proper help have a suicide rate as high as 20 percent.
When It Runs in the Family
Although the exact cause of bipolar disorder is
unknown, numerous medical studies indicate that it
runs in families. More than two-thirds of people with
bipolar disorder have at least one close relative with the
illness or with unipolar major depression, indicating
that the illness is hereditary.
Even though bipolar disorder may be considered a family
illness, there is no way to predict how it will affect other
9
family members. Concerned families should consult their
physicians if they have questions about symptoms and
should also request a screening for mood disorders at
their annual medical check-up. DBSA recommends this
kind of screening as part of every individual’s health regimen or annual physical check-up, whether there is a
history of mood disorders in the family or not.
The Child with Bipolar Disorder
There is a startling lack of research about the early
onset of bipolar disorder in children. Children as young
as three have been diagnosed with it, and more children than ever are exhibiting symptoms. Symptoms of
bipolar disorder can emerge as early as infancy. Mothers
often report that children later diagnosed with the disorder were extremely difficult and slept erratically. They
seemed extraordinarily clingy, and from a very young
age often had uncontrollable, seizure-like tantrums or
rages out of proportion to any event. The word “no”
often triggered these rages.
As with depression, the priority for parents who think
their child may have bipolar disorder is to get a correct
diagnosis. Early, accurate diagnosis and treatment are
crucial to a child’s development if he or she has a mood
disorder.
TRUE OR FALSE?
ONLY WEAK PEOPLE
GET MOOD DISORDERS
False! In fact, mood disorders tend to strike the most
intelligent, insightful and creative people. Here are individuals who have been diagnosed clinically, or are
believed to have experienced a mood disorder:
Actors/Entertainers
Marlon Brando
Drew Carey
Jim Carrey
Dick Clark
Rodney Dangerfield
Richard Dreyfuss
Patty Duke
Audrey Hepburn
Margot Kidder
Ashley Judd
Joan Rivers
Roseanne
Winona Ryder
Rod Steiger
Damon Wayans
Authors/
Journalists
Hans Christian
Andersen
James Barrie
Michael Crichton
Charles Dickens
Emily Dickinson
William Faulkner
F. Scott Fitzgerald
Larry King
Neil Simon
Mary Shelley
William Styron
Mike Wallace
Walt Whitman
Tennessee Williams
Artists
Michelangelo
Vincent van Gogh
Jackson Pollock
Georgia O’Keeffe
Business Leaders
Howard Hughes
J.P. Morgan
Ralph Nader
Athletes
Oksana Baiul
Dwight Gooden
Peter Harnisch
Greg Louganis
Elizabeth Manley
Monica Seles
Bert Yancey
10
Scientists
Sigmund Freud
Sir Isaac Newton
Composers/
Musicians/Singers
Irving Berlin
Ray Charles
Frederic Chopin
Leonard Cohen
Natalie Cole
John Denver
Stephen Foster
Peter Gabriel
Janet Jackson
Billy Joel
Elton John
Sarah McLachlan
Alanis Morissette
Marie Osmond
Charles Parker
Cole Porter
Bonnie Raitt
Paul Simon
James Taylor
Political Leaders/
World Figures
Alexander the Great
Napoleon Bonaparte
Barbara Bush
Winston Churchill
Diana, Princess
of Wales
Tipper Gore
Florence Nightingale
George Patton
George
Stephanopoulos
11
Treatment
Sometimes, it’s hard to ask
for help. If you or someone
you know has a mood disorder, you may be feeling
especially vulnerable, and
talking to someone about it
may be the last thing you want to do. But finding the
right treatment is the first step in becoming an active
manager of an illness like depression or bipolar disorder. Finding the right treatment starts with finding the
right mental health professional.
Be Sure Your Questions are Answered
Here are some questions you will want to ask your doctor. You may want to write down some of your own, or
take this booklet with you to your appointment.
■
What dosage of medication should you take, at what
time of day, and how can you increase your dosage if
this is to be done before your next visit? (Take notes if
this is complicated.)
■
What are the possible side effects of your medication(s) and what should you do if you experience a
side effect? (Ask for printed materials.)
■
How can you reach your doctor if you experience any
severe side effects or worsening of your condition?
(Be sure you leave the doctor’s office with an emergency phone number to reach your doctor.)
■
How can you identify early symptoms of an episode
and how should you respond to them? (For example,
sleeplessness can trigger mania. Treat it as a new
symptom and discuss it with your doctor.)
■
How long should it take to feel improvement and
what type of improvement should you expect?
It’s important that you feel confident in your doctor’s
knowledge, skill, and interest in helping you. You
should never feel intimidated by your doctor or feel as if
you’re wasting his or her time. If you have a problem
communicating with your doctor or you feel uncomfortable in any way, consider getting a second opinion from
another doctor or changing doctors. We use the term
“doctor,” even though your mental health care provider
may be a therapist, social worker or registered nurse. If
you and your provider decide medication is the best
course of treatment, remember that only a medical doctor can prescribe medication.
■
What are the risks associated with this treatment and,
how can you recognize them? If you have any concerns,
share them with your doctor.
■
How long will it be necessary to take your medication?
■
If the medication needs to be stopped for any reason,
how should this be done?
■
How often will you need to see your doctor? How
long will your appointments take?
■
Is psychotherapy recommended as part of your treatment? If so, what type?
A skilled and interested doctor should address most of
your concerns, but there may be questions left unanswered. Don’t leave the doctor’s office until all of your
questions and concerns have been addressed. If you
need to, write down all of your questions before the
office visit. Don’t be embarrassed to bring up any subject. Bring along a friend if it makes you feel more
comfortable or ask your questions in the doctor’s office
rather than the examining room.
■
Are there things you can do to improve your
response to treatment? Are there activities you should
avoid in order to increase your likelihood of improvement?
■
If this medication isn’t helpful, are there alternative
treatments? What might they be?
■
If someone questions why your doctor prescribed
medication, or raises doubts about possible dangers of
taking medication, how should you respond?
Choosing a Doctor
Your primary care doctor may be able to treat your
mood disorder, or he or she may refer you to a mental
health professional. If you don’t have a primary care or
family physician who can refer you to a mental health
professional, ask trusted friends, relatives or DBSA support group members if they know of one. Also, contact
your insurance company or community mental health
center to find providers available to you.
12
13
Taking Medication
“I refuse to rely on a pill to solve my problems.” Many
of us have had the same reaction when told we have a
mood disorder. How can a pill improve our attitude
toward life? Why can’t we just “learn to be happy”?
Remember, depression and bipolar illness are disorders
in the function of the brain. You are not experiencing the
symptoms of these illnesses because you are a bad person or are lacking in any way. Would you consider people
with diabetes to be “lacking” because their body’s inability to produce insulin leaves them tired and nervous?
The choice to take medication is entirely yours, but
know that many people with mood disorders have
significantly improved their lives and have saved
themselves from years of pain and self-destruction
because they’ve adhered to a treatment plan that
includes medication. Though medication does not guarantee all your problems will be solved, the right one can
improve your ability to cope with life’s problems and
restore your sense of judgment.
The Food and Drug Administration (FDA) has approved
dozens of medications to treat mood disorders. These
medications belong to various classes; each one has a
distinct chemical structure that acts on different receptors in the brain, offering different benefits. Because
everyone is different, DBSA does not advise or endorse
any particular medication or treatment. However, you
should know that all FDA-approved medications for
mood disorders work – they just don’t work the same
for everyone. Careful consultation with your doctor is
extremely important when deciding what medication to
take. Know what you’re taking, why you’re taking it,
how long you may have to take it, what side effects are
possible, and if the medication interacts with other prescription drugs, over-the-counter drugs or dietary
supplements. You are entitled to, and should, ask as
many questions as you need to feel comfortable.
What to Expect When Taking Medication
Medication is prescribed to relive a person’s symptoms.
You don’t have to experience all the symptoms listed in
this brochure to have depression or bipolar disorder.
Work with your doctor to determine a treatment strategy that is most likely to ease your particular symptoms.
14
Antidepressants are usually prescribed for depression.
Several different medication trials or a combination of
medications may be necessary to achieve sufficient
improvement and avoid troublesome side effects.
Keeping your own treatment records, including the medication, dosages used, length of time taken, and positive
or negative experiences, can be very important in helping
your doctor decide what medications to prescribe.
Symptoms of depression may lessen, and ideally disappear, with the right medication. You should expect to
feel relief within two to eight weeks, although a full
response sometimes takes 12-16 weeks. And remember:
sometimes it’s necessary to take more than one medication to achieve the desired result.
With bipolar disorder, symptoms of mania and depression are usually stabilized by mood stabilizers, which
can take up to two weeks to achieve full effect. Dosage
may be lessened or increased to fine tune treatment,
depending on your doctor’s evaluation. In addition,
your doctor may add another medication to your
course of treatment, depending on your symptoms.
A mood stabilizer is sometimes prescribed with an
antidepressant or antipsychotic.
Despite reports to the contrary, medications for mood
disorders are not addictive or personality-changing,
although you may experience feelings of withdrawal
when going off a medication. Never stop taking your
medication without talking to your doctor first.
Alternative Treatments
DBSA recognizes that dietary supplements and other
alternative treatments that are advertised to have a positive effect on depression or bipolar disorder regularly
enter the marketplace. These alternative treatments
include Omega-3, St. John’s wort, SAM-e and others.
Because of the lack of scientific data, DBSA does not
endorse or discourage the use of these treatments.
However, people should be aware that natural is not
always synonymous with safe. Different brands of supplements may contain different concentrations of the active
substance, and these alternative treatments may have
side effects or interact with your prescribed medications,
so read labels carefully and discuss them with your
doctor or pharmacist.
15
DBSA supports clinical research into alternative treatments
and advises that anyone with a mood disorder consult
their physician and/or mental health professional before
undergoing or modifying any treatment.
Electroconvulsive Therapy (ECT)
This treatment is intended for people with severe
symptoms of depression or sometimes mania. When
medications and psychotherapy fail to adequately lessen
symptoms, ECT can be a safe and effective alternative
treatment. ECT is never forced upon people or used as
a means of submission.
Mild electrical stimulation to the brain causes brief
seizures which, in turn, relieve the depression. Muscle
relaxants are administered to the anesthetized person
to eliminate shaking. An average of six to 12 treatments
over a three- to four-week period are usually required.
After successful treatment, subsequent depressive
episodes may be managed by antidepressants or less
frequent maintenance doses of ECT. Like all treatments,
ECT has potential side effects. Although there have
been reports of memory disturbances, most ECT
patients feel that the benefits far outweigh the prospect
of suffering from long-term severe, unremitting depression. This is especially true for suicidal patients who
may otherwise have carried out their impulses if they
had waited for medication therapy to take effect.
Light Therapy
The absence of full-spectrum light – light that contains all
the wavelengths of natural sunlight – can cause Seasonal
Affective Disorder (SAD), a form of depression which
typically develops during fall and winter then goes away
during late spring and summer. In about half of mild or
moderate cases of SAD, symptoms can be effectively
treated by light therapy, a treatment that exposes
patients to a type of full-spectrum light which compensates for daylight loss. Check with your mental health
professional about the type of light source to use for
this treatment.
16
Psychotherapy
Psychotherapy or “talk therapy” is an important part of
treatment for many people. It can sometimes work alone
in cases of mild to moderate depression. People who are
severely depressed may not be able to benefit from psychotherapy until their symptoms have been lifted
through another means of treatment. People with bipolar disorder and/or chronic depression usually benefit
from a combination of medication and talk therapy. A
good therapist can help you modify behavioral or emotional patterns that contribute to your illness. There are
several types of psychotherapy: interpersonal, cognitivebehavioral, group, marriage and family, to name a few.
Research the different types to find the one you feel is
most appropriate for you. Psychotherapists, although
highly-educated professionals, are not medical doctors
and therefore cannot prescribe medication.
When Hospitalization is Required
In some cases of severe depression or bipolar disorder,
physicians may recommend hospitalization for a number
of reasons: medication side effects may render one temporarily incapable of safe self-care; a drug wash
(discontinuing medication) may require a period of controlled observation; or attempted suicide or severe manic
episodes may require treatment in a safe, controlled environment. If hospitalization is recommended, be sure to
ask questions about the course of treatment and the estimated length of the stay. Also, be sure to check with your
health care provider or insurance company about the
type of coverage provided.
People are not always willing to be hospitalized. Those
who are unable to take care of themselves, or who
appear to be a threat to themselves or others, must be
admitted involuntarily. For information on your state’s
legal procedures, contact a psychiatrist, your state’s
attorney’s office, the police or the hospital emergency
room. Involuntary commitment is rare, but could prove
to be life-saving.
17
Clinical Trials
Clinical trials are research studies involving patients,
which are created and designed to answer specific scientific questions. By participating in a clinical trial, you
could help advance scientific knowledge about mood
disorders and their treatments. However, taking part
in a trial does not guarantee you individual benefits in the form of newer or safer treatments. It is
very important that you understand the potential
risks of participation before agreeing to take part
in a trial. Consult your physician when deciding
whether or not the trade-offs involved with a clinical trial are reasonable for you.
Economic Cost of
Depression
Fact: Depression and mood disorders
cost $43 billion each year.
Direct Treatment Costs
$12.4 billion
27%
Mortality Costs
$7.5 billion
17%
When participating in a clinical trial, you may also want
to find out whether there is a possibility of being
assigned an inactive pill, or placebo, and whether the
experimental treatments will be available to you when
the trial is over.
Treatment Challenges
During the last 30 years, advances in treatment have
helped many people suffering from depression and
bipolar disorder. However, at least 15 percent of those
with a mood disorder do not respond to any treatment.
As with any life-long illness, persistence and self-education are essential if you are living with a mood disorder.
Don’t give up hope. There are many new medications
and treatments under development. If treatment is not
successful, continue to work with your doctor on a plan
for living. Don’t try to self-medicate by adjusting your
own dose, combining medications without your doctor’s
permission or abusing alcohol or illegal drugs.
Treatment challenges can be frustrating, and many of us
have been there. Remember that this difficult point is
just one step on the road to recovery, not a factual statement about your life or a prediction of the future. Keep
moving forward to find the help you need – support is
out there!
18
Absenteeism
$11.7 billion
28%
Lost Productivity
$12.1 billion
28%
Source: Adapted from Greenberg, et al., “The Economic Burden of Depression
in 1990,” Journal of Clinical Psychiatry, Nov. 1993.
Did You Know?
■
According to the National Institute of Mental
Health, more than 23 million adults in the United
States are diagnosed with depression or bipolar
disorder – that’s one out of every ten people.
■
Depression commonly co-occurs with other illnesses: 50 percent of people with heart disease,
25 percent of people with cancer, and 10 to 27
percent of people who have had a stroke also
have depression.
■
41 percent of people with bipolar disorder abuse
alcohol or drugs when their illness is not being
successfully managed compared to 13 percent
when the illness is being successfully managed.
19
Support
Reaching Out
for Help
When someone is diagnosed
with a mental illness, the first
reaction he or she sometimes has is fear – What should I do? Why did this happen
to me? What’s wrong with me? Sometimes, the fear goes
deeper. The person may feel he or she is “broken” or
not good enough. This fear usually comes from stigma.
What is stigma? Webster’s Dictionary defines stigma as a
mark of shame or discredit: a stain. The fear a newlydiagnosed person sometimes feels comes from the
stigma society places on mental illness. People with
mood disorders not only have to manage their symptoms, but have to adjust to a new awareness that others
may think or say they are “crazy.” Devaluing mental illness is not acceptable. Don’t let this prevent you from
getting help. Your illness does not define who you are.
Taking Control of Your Illness
As with other chronic illnesses such as diabetes, heart
disease or asthma, people with mood disorders should
see themselves as managers of their illness. Depression
and bipolar disorder are treatable medical illnesses, but
they are not curable. It may very well happen that the
initial treatment you receive will be the only time in
your life you need medication for your disorder. For
many, though, severe depressive and/or manic episodes
reappear at some point in life. If this happens, don’t
panic. Your experience with previous episodes puts
you one giant step ahead in the process of recognizing
symptoms and getting help. Some people are treated
briefly, and finish treatment with their physician and/or
mental health professional in less than one year. For
others, daily medication and periodic visits to the psychiatrist become a part of life. By continuing your
treatment plan, you can greatly reduce your chances of
having symptoms recur.
20
Telling Others About Your Illness
You may be concerned about people “finding out” about
your illness or what people might think of you once they
know you have a mood disorder. It is your personal
choice whether or not to disclose your diagnosis to
anyone other than your mental health professional.
Most people will appreciate your honesty, and you will
help them understand how to respond to your fluctuations in mood and behavior. Because your illness or
medication side effects may impair your functioning,
employers may need to be alerted – especially if your job
involves the safety of others.
Disclosure may be especially difficult for people with
psychiatric disabilities. An employee is not required to
disclose all the details of his or her illness – only those
necessary to demonstrate eligibility for an accommodation under the Americans with Disabilities Act (ADA),
and only if an accommodation is needed. Moreover, the
employee may request confidentiality, a right protected
by the ADA. It is in a company’s best interest to safeguard your mental health and to offer reasonable
accommodations. Untreated mood disorders lead to
absenteeism, work-related injuries and lost productivity.
Share this booklet with your employer or contact DBSA
for other resources.
Self-Care
Maintaining good health is not a cure, but it can
tremendously affect your overall sense of wellness. A
good diet, exercise and regular sleep habits can help
you feel better. On the other hand, factors that contribute to mood disorders include poor sleep habits,
vitamin deficiencies, stress, other illnesses and their
treatments, drug interactions, food sensitivities, improper metabolism, social isolation and substance abuse.
Alcohol and illegal drugs may be tempting ways to cope
with stress. However, they are especially harmful when
coping with a mood disorder. Abusing them may make
your symptoms worse, and can alter the effectiveness of
medication you are taking. If you are having trouble
stopping your use of alcohol or illegal drugs, talk to
your health care provider or a trusted friend or family
member. You can also contact Alcoholics Anonymous or
other 12-step groups, whose phone numbers can be
found in your local telephone book.
21
You may find it helpful to keep a journal to chart your
activities, nutrition, health and for women, your menstrual cycle to determine possible contributing factors
to your mood disturbances and share your journal with
your health care provider.
■
Improve your diet. Avoid caffeine, sugar and heavily
salted foods.
■
Change the stimulation in your environment.
■
Attend a local DBSA support group regularly.
Suicide Prevention
For Family and Friends
If you are having suicidal thoughts, it is important to recognize these thoughts for what they are: expressions of a
treatable medical illness. Don’t let embarrassment stand
in the way of vital communication with your doctor,
family and friends; take immediate action. You can take
important first steps to manage these symptoms.
Living with a person who has depression or bipolar disorder can be a great challenge. As a family member,
friend or trusted supporter, it’s important to stay
informed about the illness and your loved one’s
progress so that you will know when to help and when
to leave matters alone. For instance, forcing a person
with severe depression to see visitors could add seriously to his or her anxiety level instead of lifting spirits. On
the other hand, letting a person stay isolated too long
during a serious depression could be dangerous if he or
she has exhibited signs of suicidal thoughts.
■
Tell your mental health professional immediately.
■
Tell a trusted family member, friend, or other support
person.
■
Regularly schedule health care appointments.
■
Instruct a close supporter to take your credit cards,
checkbook, and car keys when suicidal feelings
become persistent.
■
Make sure guns, other weapons, and old medications
are not available.
■
Keep pictures of your favorite people visible at all times.
Develop a Wellness Lifestyle
Keep the following in mind as you discover your own
ways to reduce symptoms and maintain wellness:
■
22
Regularly talk to your counselor, doctor or other
health care professional.
■
Share talking and listening time with a friend.
■
Do exercises that help you relax, focus and
reduce stress.
■
Participate in fun, affirming and creative activities.
■
Record your thoughts and feelings in a journal.
■
Create a daily planning calendar.
■
Avoid drugs and alcohol.
■
Allow yourself to be exposed to light.
With someone prone to manic episodes, try to set rules
during periods of stable mood and discuss safeguards
such as when to withhold credit cards, banking privileges
or car keys. Like suicidal depression, uncontrollable
mania may endanger a person’s life. Hospitalization may
be helpful in both cases.
If possible, take turns “checking in” so that one family
member or supporter isn’t overburdened. Alleviate
stress by focusing on other family events and activities.
If there are young children or teens in the home,
explain that the person has a medical illness that
requires continuous attention and love – and that it’s
not the result of something the young person has done.
When recovery from severe symptoms begins, let the
person approach life at his or her own pace. Try to do
things with your loved one, rather than force him or
her, so that self-confidence can be regained. Remember
that having a serious mental illness may damage a person’s self-esteem, and it will take time for the person to
become comfortable again at home, at school, among
friends and at work.
Treat the person the same way you always have as he or
she recovers, but watch for a possible recurrence of
symptoms; you may notice recurrences before he or she
does. With a caring manner, you can help by suggesting a
visit to a mental health professional.
23
The Value of DBSA Support Groups
With a grassroots network of DBSA chapters and
support groups, no one with depression or bipolar
disorder needs to feel alone or ashamed. DBSA may
offer one or more support groups in your area. Each
group has a professional advisor and appointed facilitators. Members are people and loved ones of
people living with depression or bipolar disorder. As
a complement to formal therapy, DBSA support
groups:
Helpful free publications from DBSA
Call, write or e-mail DBSA (information on the back
cover) for a free copy of any of these helpful and
informative materials, or download them at
www.DBSAlliance.org .
Bipolar Disorder: Rapid Cycling and its Treatment
Clinical Trials: Information and Options for People
with Mood Disorders
Coping With Unexpected Events: Depression and
Trauma
■
Can help increase treatment compliance and may
help patients avoid hospitalization.
■
Provide a forum for mutual acceptance, understanding and self-discovery.
■
Help consumers understand that mood disorders
do not define who they are.
Finding Peace of Mind: Medication and Treatment
Strategies for Bipolar Disorder
■
Give people the opportunity to benefit from the
experiences of those who have “been there.”
Finding Peace of Mind: Medication and Treatment
Strategies for Depression
Take the next step toward wellness for you or someone you love. Contact DBSA to locate the support
group nearest you. If there is no group in your community, DBSA can help you start one.
Healthy Lifestyles: Improving and Maintaining the
Quality of Your Life
Dealing Effectively with Depression and Manic
Depression
Helping a Loved One with a Mood Disorder
Is It Just a Mood...or Something Else? Information on
Mood Disorders for Young People
For more information
There are many reputable sources of information
about mood disorders. For additional information about medications, ask a pharmacist for
written inserts or pamphlets that accompany
medications you have questions about or consult
the Physicians’ Desk Reference (PDR) Guide to
Prescription Drugs. For more information about
the symptoms of mood disorders, consult the
Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV), available
at your local library.
Personal Calendar (A way to track moods, medications, and life events)
Suicide Prevention Card
Suicide Prevention and Mood Disorders
Support Groups: An Important Step on the Road to
Wellness.
Taking Care of Both of You: Understanding Mood
Changes After the Birth of Your Baby
Taking On (And Talking On) Bipolar Disorder Kit
Understanding Treatment Challenges: Finding Your
Way to Wellness
You've Just Been Diagnosed... What Now?
24
25
Resources
DBSA Services
Other Organizations That Offer Help
DBSA provides a variety of services, including:
The following organizations also offer information
and/or assistance with mood disorders and related
topics. DBSA assumes no responsibility for the content
or accuracy of the material they provide.
■
A global network of chapters and support
groups that bring DBSA’s mission and services
to local communities and provide a forum for
patients and family members to share coping skills
and build self-esteem. Many physicians recommend these groups for people who otherwise
may feel alone or victimized by their illness.
■
A voice in Washington, D.C. DBSA advocates
to improve availability and quality of health care,
to eliminate discrimination and stigma, and to
increase research toward the elimination of mood
disorders.
■
Free information is mailed to anyone who calls
our toll-free number, (800) 826-3632 or visits our
website, www.DBSAlliance.org. Often, calling DBSA
is the first step a person takes toward finding help
for himself/ herself or someone else.
■
Outreach, DBSA’s official newsletter. This
quarterly newsletter covers research and treatment, chapter activities, consumer awareness
and advocacy.
■
Education programs like our annual national
conference bring together hundreds of patients,
families, mental health professionals and advocates to learn about the latest developments in
mood disorders. Our programs help eliminate
stigma and emphasize the importance of symptom recognition, early diagnosis and access to
treatment.
■
Helpful staff, many of whom have experienced
a mood disorder, are available to offer guidance.
Although DBSA does not operate as a crisis hotline
or offer medical advice, callers can find someone
to direct them toward the help they need.
■
A bookstore with more than 75 of the latest
books, videos and audio tapes on mood disorders.
Topics range from finding treatment to healthy
living to personal accounts of recovery. All items
have been reviewed for their scientific value and
relevance to DBSA’s mission. Special discounts
are available.
American Foundation for Suicide Prevention
(888) 333-2377 • www.afsp.org
American Psychiatric Association (APA)
(888) 357-7924 • www.psych.org
American Psychological Association
(800) 374-2721 • TDD: (202) 336-6123
www.helping.apa.org
Anxiety Disorders Association of America (ADAA)
(240) 485-1001 • www.adaa.org
Bazelon Center for Mental Health Law
(202) 467-5730 • www.bazelon.org
Child & Adolescent Bipolar Foundation
(847) 256-8525 • www.bpkids.org
Depression After Delivery
(800) 944-4773 • www.depressionafterdelivery.com
Equal Employment Opportunity Commission
(800) 669-4000 • www.eeoc.gov
National Alliance for the Mentally Ill (NAMI)
(800) 950-6264 • www.nami.org
National Hopeline Network
(800) 442-HOPE (800-442-4673) or
(800) SUICIDE (800-784-2433)
National Institute of Mental Health (NIMH)
(800) 421-4211 • www.nimh.nih.gov
National Mental Health Association (NMHA)
(800) 969-6642 • www.nmha.org
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27
Become a Friend of DBSA
Symptoms of Depression
Yes, I want to make a difference. Enclosed is my gift of:
■ $100 ❏
■ $50 ❏
■ $20 ❏
■ Other $ ______________________________
❏
•
•
•
•
•
•
•
NAME
ADDRESS
CITY
STATE
DAYTIME PHONE
COUNTRY
ZIP
•
•
E-MAIL
■ Check (payable to DBSA)
❏
■ Money order
❏
■ VISA
❏
■ Discover
❏
■
MasterCard
•
•
ACCOUNT NUMBER
Prolonged sadness or unexplained crying spells
Significant changes in appetite and sleep patterns
Irritability, anger, worry, agitation, anxiety
Pessimism, indifference
Loss of energy, persistent lethargy
Unexplained aches and pains
Feelings of guilt, worthlessness and/or
hopelessness
Inability to concentrate, indecisiveness
Inability to take pleasure in former interests,
social withdrawal
Excessive consumption of alcohol or use of
chemical substances
Recurring thoughts of death or suicide
EXPIRATION DATE
SIGNATURE
■ I wish my gift to remain anonymous.
❏
■ Please send me____donation envelopes to share.
❏
Symptoms of Mania
■ Please send me information on including DBSA in my will.
❏
■
I have enclosed my company’s matching gift form.
❏
If you would like to make your gift a Memorial or Honorary
tribute, please complete the following:
■
In memory of/in honor of (circle one) ________________________
❏
■
PRINT NAME
Please notify the following recipient of my gift:
❏
RECIPIENT’S NAME
ADDRESS
CITY
STATE
COUNTRY
ZIP
Please send this form with payment to: DBSA
730 N. Franklin Street, Suite 501, Chicago, IL 60610-7224 USA
✁
❏
■ I’d like to receive more information about mood disorders.
❏
■ Please send all correspondence in a confidential envelope.
• Increased physical and mental activity and energy
• Heightened mood, exaggerated optimism and
self-confidence
• Excessive irritability, aggressive behavior
• Decreased need for sleep without experiencing
fatigue
• Grandiose delusions, inflated sense of
self-importance
• Racing speech, racing thoughts, flight of ideas
• Impulsiveness, poor judgment, distractability
• Reckless behavior such as spending sprees, rash
business decisions, erratic driving and sexual
indiscretions
• In the most severe cases, delusions and
hallucinations
Questions? Call (800) 826-3632 or (312) 642-0049.
Credit card payments (Visa, MasterCard or Discover) may be faxed
to (312) 642-7243. A fee will be applied on all returned checks and
resubmitted credit card charges.
Secure online donations may be made at www.DBSAlliance.org.
DBSA is a not-for-profit 501(c)(3) Illinois corporation. All donations are
tax deductible based on federal and state IRS regulations. Please consult
your tax advisor for details. All information is held in strict confidence
and will never be shared with other organizations.
Thank you for your gift!
28
29
Depression and Bipolar
Support Alliance (DBSA)
Previously National Depressive and Manic-Depressive Association
We’ve been there. We can help.
THE MISSION of the Depression and Bipolar Support Alliance
(DBSA) is to improve the lives of people living with mood disorders.
DBSA: Your Resource for Education and Support
The Depression and Bipolar Support Alliance is the nation’s largest
patient-run, illness-specific organization. Incorporated in 1986 and
headquartered in Chicago, Illinois, DBSA has a grassroots network
of more than 1,000 support groups. It is guided by a 65-member Scientific
Advisory Board comprised of the leading researchers and clinicians
in the field of mood disorders.
Depression and Bipolar Support Alliance (DBSA)
(Previously National Depressive and Manic-Depressive Association)
730 N. Franklin Street, Suite 501
Chicago, Illinois 60610-7224 USA
Phone: (800) 826-3632 or (312) 642-0049
Fax: (312) 642-7243
Website: www.DBSAlliance.org
Visit our updated, interactive website for important information,
breaking news, chapter connections, advocacy help and much more.
Production of this brochure was made possible through an
unrestricted educational grant from DBSA’s 2002 Leadership Circle:*
Abbott Laboratories
Bristol-Myers Squibb Company
Eli Lilly and Company
GlaxoSmithKline
Janssen Pharmaceutica Products
Pfizer Inc
This brochure was reviewed by Alan J. Gelenberg, M.D. Dr. Gelenberg is Head
of the Department of Psychiatry at the University of Arizona and a member of
DBSA’s Scientific Advisory Board.
©2002 Depression and Bipolar Support Alliance
Printed on recycled paper
11/02
GB 1000